- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.63 / $250.70 / $406.40
| Professional | | $159.63 | $250.70 | $406.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.41 / $541.98 / $906.81
| Professional | | $307.41 | $541.98 | $906.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.67 / $587.05 / $1,089.11
| Professional | | $341.67 | $587.05 | $1,089.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.29 / $545.67 / $972.14
| Professional | | $338.29 | $545.67 | $972.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.04 / $521.59 / $1,181.11
| Professional | | $280.04 | $521.59 | $1,181.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.17 / $479.08 / $983.29
| Professional | | $278.17 | $479.08 | $983.29 |